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Archive for December, 2014

I’m not really one for year-in-review appraisals or New Year’s resolutions. In general, I associate New Year’s with two weeks of noobs crowding the gym. (Newbies please note: if you are walking on a treadmill, the automatic cool-down period at the end is not for you. Do not walk in slow motion for five minutes while others are waiting, only to hop off and resume a brisk pace to the locker room. Seriously.)

In light of my recent injury, though, I can’t help being a bit more reflective than usual this year. I had easily the best training year of my life. I learned how to set challenging goals and not to let myself off the hook for them. I learned to train hard and successfully. Injury aside, I think also I learned how hard I can push myself, and it’s harder than I thought. As a friend said recently, “You have to cross the line now and then to figure out where it actually is.” The stress fracture, too, has been instructive. I’ve been reminded that I’m not Superwoman and no matter how good of shape I’m in, I still need to be gentle with myself. I enjoyed running this year more fully than I ever have, and I’m now even more acutely aware how precious every step is. I have realized these past few weeks how much running has become part of my identity, and how it’s become a measuring stick for how may day, or week, or life is going.

My foot continues to improve, albeit slower than I would like. Interestingly, it seems to plateau for several days at a time, and then overnight will suddenly feel markedly better. The injury first became apparent just after Thanksgiving, but I’m pretty sure that walking four miles on it at the Jingle Bell Jog and the pain that ensued after probably set things back a bit. That would put me at somewhere around week three of the healing process, which means the bone callus should be forming now. There is a distinct bump at the site of the injury now and the area is definitely less tender now, so that’s all to go the good.

Swimming really has been the silver lining to all of this, as I may have actually set myself up to drown in the Hudson next summer had I not been absolutely forced to focus on the swim. I’m far worse at it than I expected, and I never would have dedicated this much time to it if running or biking were at all possible. I don’t enjoy swimming yet, but I’ve been working hard, and after watching several YouTube videos to study up on technique I’ve definitely been able to make some headway. Last week I realized that I was “swimming flat,” meaning that my hips were staying parallel to the bottom of the pool while my upper body rotated. I finally got the reach-and-roll rhythm going and suddenly instead of flapping around, I felt like I was actually gliding through the water. Make no mistake, I’m still terrible, but I can now reliably overtake some of the oldest women in the slow lane. At any rate, my swim classes start in two weeks, and I am perhaps unreasonably optimistic that they will help tremendously.

Part of my current frustration with swimming is that I am not good enough to get a really hard, satisfying workout in. I’ve also been strength training, though, and I am finding an appreciation for pushing through a really hard set that I’ve never had before. I tend to rush through lifting, so I do best with a trainer or video to guide me on form and pace. It’s been difficult to find really challenging workout videos that don’t require a lot of high impact cardio intervals, but so far I’m most impressed with Jillian Michaels’ No More Trouble Zones. I can do most of the workout without modifications and the sets move fast enough to provide a good cardio component as well. I really do feel like I will come through this injury stronger physically, and maybe mentally as well.

Beyond the Pounding Model

If I can take any comfort in this injury, it’s that there are concrete steps I can take to support the healing process. Unlike a lot of the tweaky soft tissue injuries I’ve had in the past, this is a clear diagnosis with a clear progression of recovery. I take some satisfaction in knowing what processes should be occurring when, and how I can possibly help them along.

As soon as I began to suspect that I had a stress fracture, I started researching the condition, its causes, and the healing process. It’s actually quite interesting, and not as simple as the repeated pounding model that most of us imagine it to be. Stress fractures are certainly correlated with repetitive stress, however, studies have shown that the mechanism is far more complex. Repetitive loading causes a slight distortion in the bone, which in turn leads to decreased blood flow and oxygen to the area, particularly during long workouts. Muscle fatigue can magnify these effects as the soft tissues become less able to resist the stresses applied.

The lack of oxygen seems to then trigger the bone’s rebuilding cycle to begin. The normal cycle of tissue breakdown and rebuilding ultimately results in stronger bones, however the early stages of the process actually significantly weaken the structure. As microscopic damage occurs, osteoclast cells are sent to the area to absorb the compromised bone. In fact, osteoclasts actually cut tunnels within the existing bone structure along the lines of stress. (How cool is that?) Once the damaged tissue is cleared away, osteoblast cells come in and begin to deposit new bone within the matrix. It takes 10-20 days for the newly placed bone to mature, however, and it is during this time that the injured area is most vulnerable. If the cycle progresses normally, in about three weeks the bone is stronger and effectively reinforced along the direction of stress. If too much stress is placed on the bone during the remodeling process, however, the repair process will be interrupted, and/or damage will outpace the body’s ability to repair it. The microscopic fissures begin to merge, and a crack forms in the bone.

At this point, the injury becomes painful and activity must be reduced. As the bone begins to heal, a soft bone callus forms around the injured area. While the initial fracture is often not visible on x-rays, the bone callus will appear as a ghosted area. After about a month, the callus will begin to harden and the injury is markedly less painful. The bone is still not at full strength, however, and returning to full activity at this point can result in a recurrence of the fracture. The callus can also put pressure on adjacent bones and tissues causing a change in gait and/or pain and numbness in the area. After 8 weeks, if all goes well, the bone should be returning to full strength and normal activities can be slowly resumed.

Nutrition for Healing

For the stress fracture to heal, further stress on the bone must be limited. And while the time frame needed for the new bone to mature cannot effectively be accelerated, the rebuilding process can be supported by supplying the required minerals and nutrients, along with plenty of rest. It’s worth noting here that NSAIDs block one of the inflammatory markers that stimulate osteoblasts, and taking them will slow the healing process. Curcumin and ginger reduce inflammation without disrupting the development of new bone, however. Studies have also shown that supplementing with additional vitamins and minerals can aid healing and reduce complications:

Vitamin C & E – anti-oxidant properties help counteract the release of free radicals that occurs during a fracture

Vitamin D – aids in the absorption of calcium

Magnesium – also needed for calcium absorption, and often deficient in runners as it can be lost through sweat

In addition to the supplements above, I’ve also been adding a tablespoon of gelatin to my coffee every morning. There’s a batch of bone broth going in the crock pot, and I’m keeping my protein intake a bit higher than I normally would when I’m not running as well. (Despite runners’ tendency to not want to gain weight while they are sidelined, this is NOT the time to restrict calories.) Getting adequate rest and sleep is, of course, critically important, and that is made slightly easier by the fact that I’m not running at 6 AM every morning.

It’s hard sitting still with my foot up, it’s hard to resist the urge to put the regular pedals back on my bike and work up a good sweat, and it’s really hard to not run. I’m getting in some good strength training and am starting to see results in the pool as well. There is certainly a silver lining to be appreciated, but no matter what, getting injured sucks. I’m trying to remind myself that after a year of hard training I really do need some rest. My foot may be the most acute issue, but I will certainly benefit from a little down time and switching up the routine. I’m probably not losing as much fitness as I imagine, and even if I am, I’ll get it back. I did it once already, and it’s easier to regain fitness than to build it up from scratch. If all else fails, I’m thinking of developing a bone broth-based cocktail.

Although I’m still awaiting the results of my MRI, a trip to the podiatrist on Tuesday confirmed my suspicion of a metatarsal stress fracture. I’m now boot-bound for the immediate future, and am likely looking at 6-8 weeks before I can start running again. The good news is that I can continue to swim and I may be cleared for cycling and pool running in a few weeks.

I’m upset, of course, and disappointed that I probably won’t be able to run the Hot Chocolate 10-Miler and the Fred Lebow Half Marathon that I am registered for in January. It’s been ages since I’ve raced the shorter distances, and I was really looking forward to getting back to training in earnest. I had also planned to run the Shamrock Marathon in March, but depending on when I’m cleared to resume full training that may not be feasible either. It’s certainly not the end of the world, but as any athlete knows, injuries are incredibly frustrating and it’s easy to get a bit depressed on top of the physical trauma. I know my own tendencies in that department, so I’m working hard to reframe the situation into something positive.

I’ve realized that one of the most difficult aspects of dealing with injury for me (and I suspect for many runners who are a bit Type-A) is the loss of the structure and routine that training provides. When I’m working through an injury and can’t do my “real” workouts, I usually tend to do somewhat aimless sessions just so I can feel like I got my exercise in. This time around, I’m trying to approach time the time away from running as an opportunity to address some weaknesses that I never seem to have time for otherwise. I’m setting specific goals and building a training plan to get there. I want to improve my upper body and core strength with weight training twice a week, complete a 30-day chin-up challenge, and build up to swimming 500m with this training plan. The hard part, of course, is garnering the same level enthusiasm I have for my running. Getting better at things you’re bad at is unglamorous, eat-your-veggies kind of training–the sort that is hard and ugly and generally not much fun. Rather than running around the park with at least a modicum of grace, I’m flapping around in the pool just trying not to inhale water. The learning curve is steep at this end, but so are the incremental gains. In 6-8 weeks I may just have a new set of skills.

After a lot of rest and Advil last week, my foot was actually feeling a bit better by Friday. I have an appointment tomorrow with a podiatrist who specializes in runners and triathletes, but by the weekend I was hopeful that it might be a moot point. On Saturday I could hop without wincing, and I even wore footwear other than my running shoes to dinner. On Sunday I had a bunch of errands to do, as well as a pile of laundry and cooking for the week. I swam in the morning and then spent a good portion of the day on my feet. By evening I was visibly limping again and my chiro friend asked me if I had considered the possibility of a stress fracture. I had, of course, but mostly to convince myself that if I had one, my foot would probably hurt more than it does. After two weeks with no improvement, though, it does seem like the most likely scenario. I’m also pretty sure that the fact that I can actually feel my third and fourth metatarsals inside my foot is not a good sign. I imagine that I’ll get a definitive answer tomorrow, but just in case, I stopped taking the Advil (it can impede healing of fractures) and ate an extra bowl of bone broth soup last night. Either way, it looks like I might be spending more time training in the pool than I originally thought.

It’s now been a week and a half since I’ve run, and if anything, my foot seems worse. I made an appointment to have it looked at next Tuesday, and until then I’m just trying to stay off of it as much as possible and ice it frequently. I’ve now abandoned the nightly hope that it might possibly feel better in the morning, and I removed the next two weeks of bike workouts from my calendar because the reminders were making me sad. (I am stubbornly refusing to remove the run workouts, however.)

I have swum three times so far this week, and the jury is still out as to whether that’s aggravating it further. The injury seems to feel worst in the morning, and while I’d hoped that swimming might be an effective way to gently loosen it up, it seems just as painful when I get out of the pool as when I get in. I’m happy to report that I suck at swimming a little less every day, so that’s progress. I’ve been feeling really overwhelmed with how much work I have to do to get ready for the swim leg of the tri and, circumstances aside, I really am glad that I’ve been forced to start training a little earlier. Even knowing that I have seven months to get there, I’m still completely intimidated by the thought of an open water swim of almost a mile.

I just finished a very effective 30-day ab challenge this week, and it has me thinking that baby steps really are the way to go. (Who can do a 4 minute plank? This girl.) For some reason I had in my head that I wasn’t ready for a training plan, but after some quick searching I found a beginner’s workout plan that makes the whole endeavor seem a little more doable. Of course, this one only gets me up to swimming 500m workouts over the next month, but I have a feeling that if I can get over the initial ‘I’m completely incompetent’ hurdle it might get a little bit easier.

It’s now been a week since I first started feeling some mild discomfort from the (self-diagnosed) EDL tendinitis. As I wrote in this previous post, it escalated quickly. Walking is hit or miss; sometimes I feel almost no pain, and other times it’s quite sharp. Running, jumping, or any sort of impact is still out of the realm of possibility. Unfortunately, this weekend I was signed up for the NYRR Jingle Bell Jog, a 4-miler in Prospect Park. I haven’t run any races that short since the Israel 4-miler this spring, and I hadn’t raced it, so I was really looking forward to letting loose on this one. It’s rare NYRR races are on my home turf in Prospect and I was hoping to run 7:30ish splits and move up a corral or two.

By Friday it was clear that there would not be any running happening this weekend, but I still needed to finish the race for my 9+1 entry for next year’s NYC marathon. The Caveboy graciously offered to keep me company while I walked, which was sweet and rather brave given how grumpy I was about the whole thing. I really was trying to stay positive and upbeat outwardly, but I was in a fair bit of pain by the end and probably not very good company.

My biggest concern was whether all of the walking was going to set me back even further, but on Sunday my foot actually felt a little better. I was starting to get some taper madness and did an upper body kettle bell workout just so I didn’t feel like such a slug, but I knew it wouldn’t get me the much-needed hit of endorphins. For the rest of the day I took the opportunity to rest and ice it while watching football and catching up on my holiday knitting, and by evening it seemed like the visible swelling was gone. I was cautiously optimistic that it was on the mend, but then this morning the puffy spot was back and it seemed to hurt as much as ever. Exit Optimism. In an effort to find some kind of cardio outlet, though, I did scope out a pool to join yesterday, and a swim cap and goggles are on my errand list today.

I keep telling myself that I can turn this into a positive. I can focus on getting stronger and start swimming in preparation for the summer tri. For the first time in years, though I’m having a hard time finding the motivation to work out when I can’t do any of the activities I enjoy. I have no idea if this will take days or weeks or months to heal. (Though if it’s not showing signs of improvement by the end of the week, I’m going to get some x-rays.) Running is my prozac, and the combination of the frustration of the injury and losing my stress outlet really has me down. I think what makes this one particularly difficult is that it came on so suddenly. When I’ve had runner’s knee, plantar fasciitis, or IT band problems I could make (sometimes badly) calculated decisions about whether to run through the pain or not. I knew that it might ultimately result in having to take some time off, but I at least had a chance to mentally prepare for that eventuality. There’s nothing to do right now but to keep moving forward in whatever way I can and not let the frustration get in the way.

I call this my “harvest” salad in part because it’s seasonal, but mostly because it’s my go-to meal for using up leftovers. I seem to make one of these for dinner once a week, and it’s a perfect (and fast) post-workout lunch on the weekend. The bulk of the kale and the fact that it’s warm make it hearty while still being light, and the flavor profile options are endless. For the one I made yesterday, I used leftover roasted broccoli and Brussels sprouts that I had in the freezer, along with some butternut squash I had cubed and roasted the day before. I was also having a bowl of my Turkey Bone Broth Soup, so I didn’t add protein to the salad, but I often thrown in leftover chicken or open a can of smoked trout.

Method

Heat a skillet over medium. If your veggies are frozen, add them to the skillet with 1/4 cup of water and cover for a few minutes to defrost. Meanwhile, wash, de-stem, and cut the kale into bite-sized pieces. When veggies have softened, add the kale and drizzle with oil, tossing a bit to evenly coat. Add more water if necessary so that there is about 1/4 cup in the skillet. Cover and steam for 4 minutes, increasing the heat to medium-high. Mince the garlic and add after about 2 minutes. If you’re adding protein to the salad, put it in the skillet to warm, along with any additional spices.

After 4 minutes, remove the lid and allow the water to cook off. Toss the mixture occasionally, but allow it to sit still long enough for some of the kale and vegetables to caramelize a little. When it’s almost done, add the vinegar, salt, and pepper, and toss again. Give it one more minute on the heat, and serve.

After I finished all the cooking last weekend I savored a few minutes of quiet and sat down with my gmail calendar to plan my next few months of training. I love lists, schedules, and thinking about interval workouts, so planning the next race is pretty much my favorite thing. My spring A race is going to be the Shamrock Marathon in Virginia Beach in March, but I’m also signed up for the Fred Lebow Half Marathon in January, which is where I had set my immediate sights. I’m also gearing up for triathlon training in the spring, so I was looking forward to starting to incorporate bike and swim workouts as a two-a-day option for winter training.

Surrounded by a pile of training books (as well as multiple Chrome tabs), I crafted a fairly intense few months of morning runs and evening bike sessions, with swim classes starting up in January. I enthusiastically kicked all of this off with brick workouts or two-a-days every day over Thanksgiving weekend. I was feeling like a total beast—or at least enjoying imagining the total beast I would be after a month of biking drills. Everything was going great until Sunday, as I was finishing an 8-mile run. I noticed some mild soreness in the top of my left foot, but chalked it up to the new shoes I was still breaking in and jumped on the bike another 45 minutes to round out the day. It was still a little sore on Monday, which is my rest day. I figured the day off from running was just what I needed, but decided to go ahead with 30 minutes of one-legged pedaling drills in the evening.

Tuesday I hit the gym bright and early, ready for my first official interval session of the training schedule. Such opportunity! Such promise! Such stabbing pain behind my toes! I stopped, stretched, tried again, and ended up quitting after a quarter mile. I haven’t actually stopped a run because something hurt since, oh, 2010, so that was a big deal. “It’s great that I’ve started doing bike workouts, though,” I thought to myself. “I’ll just do spin intervals instead.” 45 minutes later I was dripping sweat and pleased with my workout as well as my positive attitude and willingness to do something other than run. I stepped off the bike, tried to put weight on my left foot, and nearly fell over. After limping around a bit and stretching I was able to walk almost normally again, but it was clear that whatever was wrong, the bike was making it much, much worse.

After a visit to Dr. Internet, I’ve diagnosed extensor tendonitis. It’s often caused by pressure from shoes that are too tight across the toe box, and I’m quite sure that my bike shoes qualify. Tight calf muscles can also contribute, and some aggressive tiger tailing that night did release some alarmingly tight muscles there. I’ve been icing my foot in the evenings, which seems to help for at least an hour or so following. After 3 days, though, walking still hurts and running doesn’t feel like a remote possibility. I also obviously can’t bike, and strapping my feet into the rowing machine seems like an equally bad idea. I did a solid strength training session yesterday, but I’m at a loss for other cross-training options. If nothing else, this may motivate me to sign up for a pool membership this weekend.

I’m trying to stay positive–at least this happened in the off season and not right before a race–but having such limited workout options is making me a little crazy. I’ve also realized that no matter how good of shape I’m in right now, I’m still a newbie at cycling and I’m probably in for a lot of the same frustrations I had when I started running. Learning new things–it’s awesome, right? This is all going to be worth it?

Every year when the turkey carcass is picked clean and the leftovers have been put away, I look at the pile of bones and think, “I should make a stock from that.” By that point in the day, however, the thought of embarking on yet another culinary undertaking always seems like too much. This year, I was prepared—I had a plan and a slow cooker.

When I roast my turkey, I always throw a mix of veggies in the bottom of the pan with about 1/3 of a bottle of wine and some herbs. It makes a delicious gravy base, and this year it served double-duty. My mix this year was celery, carrots, shallots, mushrooms, and a few whole cloves of garlic. After the turkey had roasted and the gravy had been evacuated they were still reasonably intact. I threw about a third into the bottom of the crock pot, and put the rest in the fridge for later. I put the carcass in the crock and added about a quart of water, clamped the lid on, and set it on low. I let it simmer for 24 hours, and then removed the bones and bits as best I could. The amount of meat that came off what appeared to be a pretty clean carcass was pretty shocking, but the hard part was separating out the then soft bones and connective tissue from the meaty bits. Careful work with the slotted spoon eventually prevailed, and I transferred the remaining broth and meat to a stock pot on the stove. I strained out the veggies that had been simmering overnight and added the ones I had reserved from the roasting pan. I threw in some of the leftover turkey, as well as fresh rosemary, thyme, and sage, along with salt, pepper, and a little cayenne for kick. An hour later, I had some fantastic soup on my hands. I ended up with about a quart and a half, which isn’t a bad yield for something made entirely of the bits I would normally have thrown out. I also have big plans the next time I roast a chicken…